The present invention relates to a device for supporting a surgical drape above a patient and enabling the supplying of a respirable atmosphere to a patient during a surgical operation. The atmosphere may be either an oxygen enriched air or pure oxygen. The device is used in conjunction with a surgical operating table having a patient supporting mattress thereon and with a drape or cover sheet in order to retain the supplied atmosphere for patient respiration. The drape support device described herein is of particular usefulness with respect to ophthalmological operations in which a surgical field must be maintained through an opening in a drape for operations upon the eye.
Intraocular operations upon the human eye are mostly conducted under a local anesthetic and hence the patient is awake and must be kept comfortable during the operation. Movement to a new patient position must be provided for under the direction of the operating ophthalmologist. It is desirable to let the patient seek the most comfortable attitude and to then arrange the cover drape so that the patient's breathing can be natural and unencumbered. At the same time, another major requirement is that the operating microscope field must be well presented for access by the ophthamologist. Yet another requirement is that the field be presented in a manner so that operating tools can be moved in and out without obstruction. The operating field must be maintained directly centered on the eye since a small field aperature in the drape is used to prevent the patient from looking up at the surgeon with the other eye and to maintain sanitary field conditions. Also the drape support device must be rigid once fixed in position so that accidental movement during an operation is rendered impossible. Operating room personnel often rest their hands and place various instruments on the drape. These requirements mean that the various devices and surgical implements are close spaced to the operating field which is small and delicate to properly maintain.
These critical and desirable conditions are regarded as important for intraocular surgical procedures such as cataracts extractions with or without lens implants, glaucoma treatment, corneal transplants (keratoplasties), retinal detachment treatment and exploratory orbitotomies for tumor and bone chip location. Patient comfort is less of concern for those extraocular procedures where general anesthetics are used such as for eyelid plastic surgery, strabismus (eye muscle surgery) procedures, refractive radial keratotomies procedures, and retinal surgery.
One aspect of the criticality of the spacing is that the cover sheet which is used to maintain a respirable atmosphere over the patient's nose and mouth must not be lifted or moved off of the underlying drape support device. Movement of the cover sheet is necessary in many of the devices in the prior art because the adjustment screws on those devices are located at various positions which underly the drape or cover sheet. Another general problem in the prior art is that the adjustments necessary to obtain different positions of the atmosphere supply device and the overlying cover sheet are distributed at different locations rather than being located in a single position outside of the cover sheet. Such devices require a special search for the proper set screw which then disturbs the delicate surgical procedure.
Another problem in surgical operations in which close control must be maintained over the operating field is that the underlying support device for the cover sheet should be capable of being dipped downwardly toward the patient in an arcuate motion which will folow the turn of a patient's head as the patient tries to maintain an acceptable level of comforture during the eye operation which can frequently be one hour to one and one half hours in duration.
Maintaining patient comfort can best be provided in head and neck operations by holding the cover drape a substantial distance of 5 cm to 10 cm above the patient's nose and mouth and by supplying a distributed flow of oxygen which gives a sensation of air flow across the face. This helps to alleviate apprehension arising from a mild suffocation sensation which can lead to a dyspneic (shortness of breath) condition in some patients. The oxygen flow provided reassures the patient and permits better surgery results.
U.S. Pat. No. 2,180,480 to M. G. Richardson illustrates some of the above problems. The set screws which allow adjustment of the anesthetics screen support frame immediately underlie the cover screen and hence it is necessary to lift the drape off of the support in order to adjust the same to various positions. Also in this device, there is no provision for the inflow of oxygen.
U.S. Pat. No. 3,347,544 to Uffenorde discloses a head rest for eye surgery having a nonadjustable anesthetic screen support attached thereto. The fixed position of this type of device has been found to be unacceptable. U.S. Pat. No. 3,482,571 to Behrendt shows a similar head rest with an oxygen tube support means.
U.S. Pat. No. 2,628,803 to Krewson shows an anesthetic screen support device for use during eye surgery in which the set screws are covered over by the screen material. Also, in this device it is not possible to follow the patients head movements since no single adjustment motion permits following of the turning of a patient's head.
U.S. Pat. No. 2,290,437 to Kilgore et al shows a support structure for use in eye operations. The upper thumb screw can only be adjusted by removing the overlying screen material. The gas supply tube is not supported for making an arcuate motion inward and outward toward and away from the patient and there is no provision for distribution of the gas flow over the patient's face. U.S. Pat. No. 3,530,515 to B. Y. Jacoby shows a patient guard for use during eye surgery which presents problems similar to the Kilgore device as does the device shown in German Pat. No. 2,614,202.
U.S. Pat. No. 2,963,247 to G. L. Collier et al. shows a form of an endotracheal tube holder which is not functional for eye operations or for supporting a drape.
U.S. Pat. No. 3,877,691 to Foster shows a flexible arm anesthetic shielding device which does not support a cover drape, supply oxygen nor provide the required rigidity of support for ophthalmological operations.
U.S. Pat. No. 3,859,993 to Bitner shows a largely nonadjustable oxygen supply and drape sheet for eye surgery in which the oxygen flows too far from the patient's face to alleviate a suffocation sensation.
Other medical and/or surgical devices having various types of positioning adjustments are disclosed in U.S. Pat. Nos. 3,026,079, 3,625,219 and 3,881,477. British Pat. No. 807,407 published Jan. 14, 1959 also shows an anesthetic gas supply tube and an adjustable support therefore.